Endocrine Abstracts

Aim: To estimate pituitary disfunction development in patients with micro and macroadenonas before and after transnasal adenomectomy.

Methods: A total of 222 patients at the age from 17 to 71 with pituitary adenomas were operated from 2007 to 2013. According to size the pituitary adenomas were classified as microadenomas (diameter less than 10 mm) and macroadenomas (more than 10 mm). Dynamic observation and redetermination of all hormones were performed within 1, 3 and 12 months postoperatively.

Results: Before the surgery pituitary hormone deficiency had been found in 32.2% patients with pituitary macroadenomas: diabetes insipidus – 2%, secondary hypothyroidism – 9%, secondary adrenal insufficiency – 10%, hypogonadotropic hypogonadism – 13%. Their combination was found in 2% of cases. Among microadenomas preoperative hormone deficiency was not detected.

In 2.2% of patients postoperative recovery of pituitary function was observed (1 case of hypothyroidism, 1 – adrenal insufficiency, 2 – hypogonadism). Newly developed postoperative hypofunctions were recorded in 9% (3% of microadenomas, 19% of macroadenomas): diabetes insipidus – 9.9%, secondary hypothyroidism – 9%, secondary adrenal insufficiency – 2.2%, hypogonadotropic hypogonadism – 3.6%, cerebral salt-wasting syndrome – 0.45%. Combination of several postoperative hypofunctions was diagnosed in 3.5%, panhypopituitarism was diagnosed in 7%. There were no significant differences in types of postoperative pituitary dysfunction in patients with micro and macroadenomas. Postoperative hypopituitarism was diagnosed in the first 7 days after surgery in all cases. During the dynamic observation within 1, 3 and 12 months postoperatively new cases of hypopituitarism were not detected.

Conclusion: In patients with macroadenomas hypopituitarism develops more often, patients with microadenomas are also at risk. Data concerning pituitary functions over long term follow up in patients with adenomas is contradictory, so we recommend all patients after transnasal surgery undergo short and long term monitoring to exclude hypopituitarism.